Umbilical Hernia in Children

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What is an umbilical hernia?

An umbilical hernia is a bulge out of the abdominal wall within the navel that sometimes contains abdominal tissue, a loop of intestine, fat, or fluid. An umbilical hernia is usually present at birth. But it is often not noticeable until the umbilical cord stump falls off, a few days to a few weeks after birth. Normally, umbilical hernias are not painful or dangerous.

Umbilical hernias can vary in size from less than 1 cm (0.4 in.) to more than 4 cm (1.6 in.) across. But they rarely measure more than 2 cm (0.8 in.) across.

What causes an umbilical hernia?

The ring of muscle and other tissue that forms where blood vessels in the umbilical cord enter a fetus's body is known as the umbilical ring. Normally the umbilical ring closes prior to birth. If it does not, tissue may bulge through the opening or weak spot through the navel.

It is not known exactly what prevents complete closure of the umbilical ring, but many factors that affect the developing fetus are probably involved. For example, in premature infants, it may be that the abdominal wall is not fully developed before birth.

What are the symptoms?

The main symptom of an umbilical hernia is a soft bulge under the skin of the navel. You may be able to push part of the hernia so that it temporarily moves back into the abdomen. The hernia may be more noticeable when your child sits or stands upright or strains abdominal muscles during normal activities such as crying, coughing, or having a bowel movement.

How is an umbilical hernia diagnosed?

A doctor can usually diagnose an umbilical hernia by examining your child's abdomen and evaluating the size, shape, and appearance of the hernia.

How is it treated?

Most umbilical hernias close on their own without treatment by the time the child is 5 years old, and usually within the first year of life. Umbilical hernias may close slower in African-American children. Surgery typically is needed to repair an umbilical hernia that has not closed by age 5, because it is unlikely to close on its own.

The likelihood that an umbilical hernia will heal on its own depends in part on how large it is.

Frequently Asked Questions

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	Should my child have surgery for an umbilical hernia?

The main symptom of an umbilical hernia is a soft bulge under the skin of the navel, or umbilicus. An umbilical hernia is usually not painful or harmful.

An umbilical hernia:

• Is usually present at birth but may not be noticed right away. A hernia usually isn't noticeable until the umbilical cord stump falls off, which usually occurs a few days to a few weeks after birth.
• May vary in size from less than 1 cm (0.4 in.) to more than 4 cm (1.6 in.) across but rarely measures more than 2 cm (0.8 in.) across.
• Can be pushed back (reduced) into the abdomen.
• Usually is most noticeable when your child sits or stands, or is straining during normal activities such as crying, coughing, or having a bowel movement. Typically, it is least visible while your child lies quietly on his or her back.

Some umbilical hernias have a large amount of extra skin over them. These are called proboscoid umbilical hernias. Although they are not dangerous, proboscoid hernias usually are more noticeable than other umbilical hernias because of their unusual appearance.

Complications of umbilical hernias, such as rupture of the hernia or trapping of the intestines in the hernia sac, are rare. But if they occur, you may notice additional symptoms in your child, such as nausea, vomiting, pain, or redness and swelling within the bulge of the hernia.

A doctor usually diagnoses an umbilical hernia during a physical examination. During the exam, your doctor will pay close attention to:

• The size, shape, and appearance of your child's abdomen, particularly the area around the navel (umbilicus).
• Whether the hernia can be pushed back (reduced) into the abdomen. With most umbilical hernias, this can be done easily without causing pain.
• The size of the open umbilical ring.

Your child should be warm, relaxed, and comfortable during the exam. Your doctor may want to evaluate the hernia in various positions and will have you help your child stand, sit, or lie down.

Follow-up appointments are important to help your doctor monitor whether the hernia is closing on its own.

Almost all umbilical hernias close on their own without treatment, usually by the time the child is 1 year of age. If an umbilical hernia does not close on its own by age 5, surgical repair usually is needed. For more information, see:

Should my child have surgery for an umbilical hernia?

Types of surgery that may be done include:

• Umbilical hernia repair. Umbilical hernia repair is the main surgery used for an umbilical hernia that does not correct itself. It is usually an outpatient procedure with low risk. Your child can go home the same day surgery is performed. During the procedure, your child is given general anesthesia. A small incision is made just below the navel (umbilicus), and any loops of the intestines and other tissue that have protruded into the hernia sac are pushed back inside the abdomen. Then the muscles and connective tissues of the umbilical ring are repaired, and the incision is closed, leaving a small scar inside the navel.
• Surgery to improve the appearance of the navel. Sometimes the navel looks abnormal after surgery. This is more likely to occur if the umbilical hernia was very large or if excess skin was over the hernia (proboscoid hernia). In these cases, additional surgical techniques may be used to help improve how the navel looks.

Problems caused by umbilical hernia surgery are very rare but may include:

• Infection.
• Localized swelling caused by the accumulation of fluid at the site of the wound (seroma).
• Bleeding or blood clots at the site of the wound (hematoma).
• Recurrence of the hernia.
• Part of the intestine being injured during surgery.

What to Think About

Surgery to repair an umbilical hernia before a child is 5 years old is usually not necessary. But surgery may be performed earlier if:

• The hernia is large [1.5 cm (0.6 in.) or more across] and has not shown any signs of closing on its own by age 2 years.
• The child or the parents want the hernia repaired for social, cosmetic, or other reasons. This may be a consideration if the child has a proboscoid hernia. Some children or their parents may find this type of hernia distressing, or the child may play with or irritate the protrusion of skin.
• Complications, such as a loop of the intestines becoming trapped in the hernia sac (incarceration or strangulation), require emergency surgery.

Home treatment is not appropriate for an umbilical hernia. Folk remedies, such as strapping a coin over the hernia or using a band or a strap to try to make it smaller, do not help. These remedies may even make the problem worse, such as by causing an infection or by cutting off the blood supply to the tissue inside the hernia, which could lead to emergency surgery.

Your doctor will want to examine your child regularly to see if the hernia has begun to close. Be sure to go to all appointments for these exams and for regular childhood checkups. Also, watch for any signs of complications related to the hernia, such as strangulation, that may require immediate treatment.

After surgery

If surgery is needed to repair an umbilical hernia, home treatment can help your child during recovery.

A child who has just had surgery to repair an umbilical hernia will need pain medicine, such as Tylenol, for a couple of days or longer. Follow your doctor's instructions on how to care for the wound until it heals, such as keeping the surgical site clean and dry. Continue to watch the incision area as it heals. Immediately report any signs of infection, such as redness, swelling, pain, drainage, or fever.

Be sure to keep all appointments for follow-up exams. Your doctor needs to make sure the area heals properly and that problems do not develop.

Organization

• Inguinal Hernia

Other Works Consulted

• Cowles RA, Stolar CJH (2006). Abdominal wall defects and disorders of the umbilicus. In FD Burg et al., eds., Current Pediatric Therapy, 18th ed., pp. 260–263. Philadelphia: Saunders.